View Full Version : Question from a hopeless noobie re:Concerta


Buenavista
02-17-10, 12:42 PM
Apologies for my newness here but I am really struggling today and am hoping to get some input from others who have been before me.

13 year old son has been "diagnosed" with Predominantly Inattentive Type ADHD by our family pediatrician and a child psychiatrist. His symptoms are mild - mostly he is just doing terrible at school but if I organize everything and track every thing and do everything but turn it in for him myself (you know how it is) then he is a B and C student in "pre-AP" (some sort of advanced, but not honors) classes. I can continue to do this for him for a while but worry he will bomb out in high school or college when I can't do it all for him anymore. No behavior problems at all. Good natured kid.

Ok, so the pediatrician says Straterra but I wanted a second opinion and went to a child psychiatrist (highly recommended, 11 years in practice) who recommended Concerta 27mg. When gave me the scrip he tells me to cut the pill in half for 7 days to make sure he can tolerate the medicine. He says "the pharmacist will tell you this isn't possible, but it is". So I come home and do internet research - EVERYTHING I read says you cannot cut this pill in half.

He has been in practice for 11 years and we certainly aren't the first ones he's told this to so he must know what he's talking about. But I'm worried if I cut this pill in half that it will some how effect the "slow release" of the medicine and that I could end up hurting my son! But I'm also scared to give him a full pill if the doctor only wanted him to take a half for a week first.

Has anyone else been told by a doctor to cut Concerta in half and successfully been able to do so? Are there any safety concerns with doing so? The pharmacist just said that I wouldn't be able to, that it would crumble, but he didn't mention it being harmful to try. I guess I will call back and ask.

Anyway, thanks for any info you might have!

tessmesser
02-17-10, 04:48 PM
The outer coating is immediate release. The inner part of the pills dissolves using osmotic pressure. If you cut it you will get 1/2 of the immediate release and the rest will disolve over a period of 12 hours. It will crumble a bit when you cut it because it is not scored but you can still give half of it and it will not effect the release of the rest of the medicine and he will get half the dose.

Tess http://primarilyinattentiveadd.com

tessmesser
02-17-10, 06:58 PM
I stand corrected. I had originally spoken to a pyschiatrist who agreed with your psychiatrist that the pill could be broken. I then called three pharmacist, I work at a large hospital who said that the way that the concerta is released after breaking the capsule is inconsistent and that it is not guaranteed to release over 12 hours if the pill is broken.

I think that this pill, according to the pharmacist is not MEANT to be broken and that if the doctor wanted your son to have less medicine there are many ways to accomplish that which does not involve cutting a concerta in half. Sorry for the earlier misinformation.

Tess

Lady Lark
02-17-10, 08:50 PM
There are lower doses of Concerta available then 27, so I have to wonder why he didn't prescribe that instead. And like tess said, it won't be the "correct" effectiveness if done that way. I don't know of any harmful side effects to using half, but I can't see how he'd get the even time release he's supposed to either.

One thing I am wondering, why do you say he was "diagnosed"? (wondering about the quotes) Is it because you don't feel he really has ADD, or is it because you don't feel a pediatrician can diagnose that, or something else entirely?

MuscleMama
02-17-10, 09:32 PM
My son takes 18mg of concerta - one pill.

Tisha
02-18-10, 09:28 AM
First, let me tell you I sense your sadness and confusion in your post. My son, also 13, was just diagnosed last November with ADHD-inattentive. He has a good work ethic, but takes twice as much time to study to get B's and C's as those without ADHD. I've worked closely with him since first grade, thinking he had some sort of reading/comprension LD. Finally had him tested. No LD's, but working memory and other items tested came in very very low. He has a great personality, I just love that kid, love to be around him.

Well, I am just now (4 months later) coming out of the denial stage. I started him on Vyvance 30 mgs, didn't see drastic results and put him on 60mg. I created a zombie, no life, no personality. Grades went up with less effort but the best part of who he is was gone. Took him off 2 weeks ago.

I've really had a hard time grappling with this. I say to myself, "well, he's not flunking, he works hard and gets B/C". But after reading and researching, I've come to the conclusion that it is REAL. And although his is not what I consider bad (in comparison to his brother), it will become life hindering when he hits high school or maybe even next year...and my sweet cheerful son might not be so cheerful. I have read that we have to grieve to get to acceptance. I am grieving this week. I cry after reading articles. I cry when I think my sons have to take pills, I cry thinking about that their lives are going to be harder for them, I cry that the road isn't normal and easy for us as a family. I grieve the loss of "my dream" of what it was supposed to turn out like for my kids.

I'm going to our ped on Friday and talking to him. I might make another appt. with the educational psychologist who tested him. I read here that large doses don't work for Inattentive very well...usually it's smaller doses. We'll have to try that, maybe try Concerta. I don't know.

I'm not sure why they want to put your son on Strattera. I thought that they usually wanted to start with Concerta or Vyvance since it's smooth, and the stimulant might work better.

anyway, I would love to get a teen support board started here. We have all sort of different issues. Good luck,

Tisha

Lady Lark
02-18-10, 12:22 PM
A stimulant medication (Concerta, Adderal, Ritalin) is usually the first line that is trying since it has a well documented success rate. A non-stimulant (like Strattera) would be second, and 3rd (If I'm remembering correctly) is some of the anti-depression medications.

That doesn't mean it's always done that way, or has to be done in that order. There could be underling health concerns that would warrant a non-stim first, or parental concerns since there is a fair amount of "horror" stories out there about stimulant medications, as well as a good amount of misinformation.

Buenavista
02-18-10, 03:58 PM
Thank you for all the responses. I apologize for putting "diagnosed" in quotes. I think I was just frustrated (as are we all I'm sure) over the fact that there isn't any definitive test (like a blood test) and treatment just seems so gray instead of the black and white decisions that I prefer to tackle and resolve. But for a long time I just chalked up my sweet son's behavior to typical teenage boy problems and I'm just now slowly turning around enough to see it's absolutely something more than that. Last night he said to me that sometimes in class when the lectures really drag on he gets to the point where he can't even hear the teacher anymore. My hope is (this is how I picture it in my head anyway) that this drug will clear away the fog and cobwebs in his brain and he'll be able to concentrate clearly and will like school. Oh, and it will happen on the first drug we try ... and there will be no side effects ... and it won't change his personality. Dream world!

Thank you for the input. And thank you Tish - your son sounds like mine. He's just a great kid to have around. For all his shortcomings at school he's got a great personality and a good heart. I hope his school (and your sons') see and value that and not just label him as a disorganized kid with bad handwriting!

I don't know why the doctor didn't proscribe 18 mg to begin with. That had been one of my questions. My son's stepmom is a nurse and got involved and has called the doctor so many times now that I'm hesistant to call again. But he did walk her through the process of cutting the pill, what she would see, etc. And it's only for a week. He starts this Saturday because I didn't want him to try it out at school in case he had any bad side effects and needed help from us.

Codykins
02-18-10, 04:01 PM
First, let me tell you I sense your sadness and confusion in your post. My son, also 13, was just diagnosed last November with ADHD-inattentive. He has a good work ethic, but takes twice as much time to study to get B's and C's as those without ADHD. I've worked closely with him since first grade, thinking he had some sort of reading/comprension LD. Finally had him tested. No LD's, but working memory and other items tested came in very very low. He has a great personality, I just love that kid, love to be around him.

Well, I am just now (4 months later) coming out of the denial stage. I started him on Vyvance 30 mgs, didn't see drastic results and put him on 60mg. I created a zombie, no life, no personality. Grades went up with less effort but the best part of who he is was gone. Took him off 2 weeks ago.

I've really had a hard time grappling with this. I say to myself, "well, he's not flunking, he works hard and gets B/C". But after reading and researching, I've come to the conclusion that it is REAL. And although his is not what I consider bad (in comparison to his brother), it will become life hindering when he hits high school or maybe even next year...and my sweet cheerful son might not be so cheerful. I have read that we have to grieve to get to acceptance. I am grieving this week. I cry after reading articles. I cry when I think my sons have to take pills, I cry thinking about that their lives are going to be harder for them, I cry that the road isn't normal and easy for us as a family. I grieve the loss of "my dream" of what it was supposed to turn out like for my kids.

I'm going to our ped on Friday and talking to him. I might make another appt. with the educational psychologist who tested him. I read here that large doses don't work for Inattentive very well...usually it's smaller doses. We'll have to try that, maybe try Concerta. I don't know.

I'm not sure why they want to put your son on Strattera. I thought that they usually wanted to start with Concerta or Vyvance since it's smooth, and the stimulant might work better.

anyway, I would love to get a teen support board started here. We have all sort of different issues. Good luck,

Tisha

Maybe you need to back off on the dose and give it some more time or split the second 30mlg in half (using water) and see if that helps. My 8 year old is on 30mg of Vyvanse and his personality is still as great as before. He dosen't sometimes have quiet periods but I beleive its more about him just focusing more something other than his sillyness.:)

hollywood
02-18-10, 04:47 PM
Honestly, I don't think concerta would be the first medication in line that I would choose in I were in your shoes. If I were in your shoes I would want to know first if the medication worked and then what dose would respond to. Taking concerta honestly may not give you those results for several reasons. For what it's worth the drug is supposed to deliver .22% initially which I feel is off in my case. I have reflux so you may factor that in to the equation, but the bottom line is that with concerta absorption in the gut will become an issue and create problems. I would trial immediate ir ritalin first and have the doc write of a rx that looks like this. ( 5mg ritalin ir, 10mg ritalin ir and then break you out some quantities for 2-weeks. You can try the varying doses and see the outcome. Dose in the morning and then at mid day or late evening if needed. If you get more coverage initially then use as directed. Ritalin will generally last 3-4 hours then you drop off. If you have success with ritalin stick with it , if not move to ir adderall and develop a similar strategy. The point is that yes is xr medication conveniant yes, but its not more efficacious.

MuscleMama
02-18-10, 09:42 PM
I agree with Hollywood. That's what our Dr recommended. First we tried adderall which wasn't a good fit. Then we tried ritalin which was good. We then switched to concerta.